To help control health care costs, an increasing number of health insurers and employers are applying principles of consumerism through "consumer-driven" high-deductible plans. High deductibles are often accompanied by health savings accounts that plan holders can use to pay for deductible expenses. The federal Deficit Reduction Omnibus Reconciliation Act of 2005, signed into law in February 2006, applies principles of consumerism for the first time to public plans, by allowing states to modify Medicaid by implementing deductibles supplemented by "health opportunity accounts" (HOAs) that beneficiaries will use to pay deductible expenses. Consumerism may promote informed health care-seeking behavior and thereby help control Medicaid costs, but some experts are concerned that deductibles place vulnerable Medicaid child and adult beneficiaries at risk. No one has determined which Medicaid beneficiaries have health care expenditures within a range that would be appropriate for HOAs and yet would place them at low risk for having to pay for deductible expenses out of pocket. The Medical Expenditure Panel Survey (MEPS) dataset is ideal for investigation of these issues, and will permit the investigators to magnify the impact of this new federal legislation for policymakers, Medicaid programs, and individuals affected by the HOAs initiative. Specific aims include: (1) To identify the socio-econo-demographic and health care characteristics of children and adults enrolled in Medicaid whose expenditure patterns in MEPS indicate that they would fall within acceptable ranges for HOA programs and have low likelihood of exceeding HOA allocations; (2) To use the 2-year panel format of MEPS waves to follow individuals on Medicaid over time, to model the risk for exceeding HOA allocations for hypothetical cohorts of individuals identified through Aim #1; (3) For the models in Aim #2, to estimate the net fiscal impact of HOA initiatives for Medicaid programs. Findings will have immediate relevance for implementation of the HOA projects and other consumerism efforts. [unreadable] [unreadable] [unreadable]